Scope of care
Pathways provide services to persons with acquired brain injuries, ages 18 and above. The diagnoses accepted include traumatic brain injuries, strokes, aneurysm, anoxic encephalopathy, brain tumors and gunshot wounds to the head. The average length of stay is 120 days. The average age is 50 years.
What separates Pathways from a regular skilled nursing setting
- Pathways must provide 3 hours of licensed therapy 5 days a week. (900 min of therapy vs 300-600 minutes of therapy in skilled nursing)
- The Medical Director must have a formal residency in brain injury treatment, being a Physiatrist (Physical Medicine and Rehabilitation) or Neurologist. The Pathways Medical Director is also the attending physician. He is a Board Certified Physiatrist and has been with the Program since 1995.
- Pathways Medical Director visits 4 times a week.
- According to CARF guidelines, the Pathways team must include physician, nursing, social work, PT, OT, SP, and recreation therapy.
- Pathways has a neuropsychologist with the ability to perform neuropsychology testing 3 days a week.
- Weekly on-site visits from the psychiatric health nurse practitioner
- Traumatic Brain Injury
- Cerebral Vascular Accidents
- Toxic poisoning
- Gunshot wounds to head
- Subarachnoid hemorrhage
- Brain Tumors
- Neurobehavioral management
Prior to the Pathways Brain Injury Program, the Kentucky Medicaid Program was sending Medicaid patients out of the state for specialty rehab programs. When patients are transferred out of state, it is more difficult for families to visit and be involved in the rehabilitation program. In some cases. Patients were being kept out of the state for over 2 years. In 1990, the state of Kentucky developed the Medicaid Nursing Facility Brain Injury Guidelines. The guidelines were developed from the Commission for Accreditation of Rehabilitation Guidelines to ensure that the brain injury program would provide acute rehabilitation services than a traditional nursing home. In addition to meeting the guidelines in the state nursing facility manual, the facility is also required to be accredited by the Commission for Accreditation of Rehabilitation Facilities (CARF) within the first year of operation.
Pathways opened in June 1990 in a skilled nursing setting in Elizabethtown Kentucky. CARF accreditation was received in June 1991 and the unit has maintained CARF accreditation since. In 1994, the unit moved to Louisville to the Christopher East Nursing Facility (now Louisville East Post-Acute). The 28-bed unit remains on a secured wing of this facility containing its own nurse’s station and therapy gym.
In 1998 the unit took 8 of the beds in the unit to utilize as a neurobehavior unit for patients who could not go to residential placements and were not manageable in a home or regular nursing home due to behaviors. Patients in that unit have primary brain injury diagnosis as well as psychiatric diagnosis.